The objective of this study was to determine how the neonatal mortality rate has changed since surfactant (S) therapy was introduced in our Neonatal Intensive Care Unit (NICU), and to evaluate the efficacy of surfactant therapy in respiratory distress syndrome (RDS) patients. Incidences of risk babies such as outborns, prematurity, low birth weight infants and RDS, and neonatal mortality rates were compared between 'pre' (control, 1988 to 1991, n=4,861) and 'post' S period (study, 1993 to 1996, n=5,430). In RDS patients of 'post' S period, neonatal mortality rate was compared between S-treated and non-treated patients, and chest X-ray and ventilatory parameters were compared between pre- and post-72 hr of surfactant treatment. Surfactant therapy showed short term effects, judging by the decrease of early neonatal deaths and improvement of chest X-ray and ventilatory parameters in RDS patients. The overall neonatal mortality rate had a tendency to decrease in spite of increased incidences of risk babies in 'post' S period but it was less than expected. The reasons were thought to be that we had a high proportion of risk babies, and there was some bias in patient selection for surfactant therapy and its use. In conclusion, with the active prevention of risk baby delivery and appropriate use of surfactant, better results could be expected.
Female ; Human ; Incidence ; Infant Mortality ; Infant, Newborn ; Male ; Pulmonary Surfactants/therapeutic use* ; Respiratory Distress Syndrome/mortality* ; Respiratory Distress Syndrome/epidemiology ; Respiratory Distress Syndrome/drug therapy* ; Risk Factors

Acute Lung Injury ; epidemiology ; etiology ; therapy ; Humans ; Respiratory Distress Syndrome, Adult ; epidemiology ; etiology ; therapy

BACKGROUNDAcute hypoxemic respiratory failure (AHRF) often develops acute respiratory distress syndrome (ARDS), and its incidence and mortalities in critically ill pediatric patients in China were 2% and 40% respectively. This study aimed at prospectively investigating incidence, causes, mortality and its risk factors, and any relationship to initial tidal volume (V(T)) levels of mechanical ventilation, in children £5 years of age with AHRF and ARDS.

METHODSIn 12 consecutive months in 23 pediatric intensive care units (PICU), AHRF and ARDS were identified in those requiring > 12 hour intratracheal mechanical ventilation and followed up for 90 days or until death or discharge. ARDS was diagnosed according to the American-European Consensus definitions. The mortality and ventilation free days (VFD) were measured as the primary outcome, and major complications, initial disease severity, and burden were measured as the secondary outcome.

RESULTSIn 13 491 PICU admissions, there were 439 AHRF, of which 345 (78.6%) developed ARDS, resulting in incidences of 3.3% and 2.6%, and corresponding mortalities of 30.3% and 32.8% respectively along with 8.2 and 6.7 times of relative risk of death in those with pneumonia (62.9%) and sepsis (33.7%) as major underlying diseases respectively. No association was found in V(T) levels during the first 7 days with mortality, nor for V(T) at levels < 6, 6 - 8, 8 - 10, and > 10 ml/kg in the first 3 days with mortality or length of VFD. By binary Logistic regression analyses, higher pediatric risk of mortality score III, higher initial oxygenation index, and age < 1 year were associated with higher mortality or shorter VFD in AHRF.

CONCLUSIONSThe incidence and mortalities of AHRF and ARDS in children £5 years were similar to or lower than the previously reported rates (in age up to 15 years), associated with initial disease severity and other confounders, but causal relationship for the initial V(T) levels as the independent factor to the major outcome was not found.

Child ; Child, Preschool ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Pneumonia ; complications ; epidemiology ; mortality ; Respiratory Distress Syndrome, Adult ; epidemiology ; mortality ; Respiratory Insufficiency ; epidemiology ; mortality ; Sepsis ; complications ; epidemiology ; mortality

BACKGROUNDPopulation based epidemiologic study on the main diseases and birth status of liveborn neonates remains scarce in China, especially in rural areas where a large number of neonates are born. The aim of this study was to establish an epidemiological basis of live births in Julu County, a representative of the northern and mid-western parts of China in terms of demography, disease pattern and women and children's health care infrastructure.

METHODSThe perinatal data of all live births were prospectively collected in three participating county-level hospitals from September 1, 2007 to August 30, 2008.

RESULTSThere were 5822 live births in these hospitals. Among all live births, 53.7% were male and 4.5% were born prematurely. Mean (SD) birth weight (BW) was (3348 ± 503) g. The low (< 2500 g) and very low BW (< 1500 g) infants accounted for 3.8% and 0.5% of the total births, with 6.5% as small for gestational age and 2.8% as multi-births. Cesarean section rate was 30.2%, of which 68.6% were elective. There were 745 infants (12.8% of the live births) admitted to local neonatal wards within 7 days of postnatal life, in which 48.3% and 19.3% were due to perinatal asphyxia and prematurity, respectively. The incidences of perinatal aspiration syndrome, transient tachypnea and respiratory distress syndrome were 4.9%, 0.6% and 0.5%, respectively. Neonatal mortality was 7.6‰ (44/5822), with 16 in delivery room and 28 in neonatal ward before discharge.

CONCLUSIONSThis study provided a population-based perinatal data of live births and neonatal mortality in a northern China county with limited resources. Neonatal disorders related to perinatal asphyxia remain a serious clinical problem, which calls for sustained education of advanced neonatal resuscitation and improvement in the quality of perinatal-neonatal care.

Asphyxia Neonatorum ; epidemiology ; Birth Weight ; China ; epidemiology ; Female ; Humans ; Infant Mortality ; Infant, Newborn ; Infant, Newborn, Diseases ; epidemiology ; therapy ; Male ; Prospective Studies ; Respiratory Distress Syndrome, Newborn ; epidemiology ; therapy

OBJECTIVE: To study the association of different stages of histological chorioamnionitis (HCA) with the incidence rate and severity of respiratory distress syndrome (RDS) in preterm infants. METHODS: Related data were collected from the infants and their mothers who were treated in the Neonatal Intensive Care Unit of Qingdao Women and Children's Hospital, Qingdao University, from January 2018 to June 2020. According to the presence or absence of HCA and its stage, the infants were divided into four groups: control ( RESULTS: Compared with the control and late-stage HCA groups, the early-stage HCA group had a significantly lower incidence rate of placental abruption and a significantly higher rate of prenatal use of antibiotics ( CONCLUSIONS Early-, middle-, and late-stage HCA can reduce the incidence rate of RDS in preterm infants. HCA stage may not be correlated with RDS severity in preterm infants, which needs to be verified by further research.
Birth Weight ; Child ; Chorioamnionitis/epidemiology* ; Female ; Gestational Age ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Pregnancy ; Respiratory Distress Syndrome, Newborn/etiology*

PURPOSEEarly intramedullary nailing (IMN) within the first 24 h for multiply injured patients with femoral fracture and concomitant thoracic trauma is controversial. Previously published studies have been limited in size and their outcomes have been inconclusive. A meta-analysis was conducted to evaluate the available data in order to guide care and help improve the outcomes for these patients.

METHODSWe searched the literature up to December 2011 in the main medical search engines and identified 6 retrospective cohort studies that explored the safety of early IMN in patients with both femoral fracture and chest injury. Our primary outcome was the rates of pulmonary complication (pneumonia, adult respiratory distress syndrome, fat embolism syndrome), multiple organ failure (MOF) and mortality.

RESULTSWe found no statistically significant difference in the rate of pulmonary complications, MOF or mortality in the patients treated with early IMN.

CONCLUSIONEarly IMN for femoral fractures does not increase the mortality and morbidity in chest- injured patients in the studies analyzed.

Femoral Fractures ; surgery ; Fracture Fixation, Intramedullary ; adverse effects ; methods ; mortality ; Humans ; Multiple Organ Failure ; epidemiology ; Pneumonia ; epidemiology ; Respiratory Distress Syndrome, Adult ; epidemiology ; Thoracic Injuries ; surgery

OBJECTIVETo observe the influence of premature rupture of membranes (PROM) on neonatal health.

METHODA retrospective cohort study was conducted among 3320 in-patient newborns of Bayi Children's Hospital from October 2006 to March 2008. One hundred term newborns and one hundred preterm newborns with PROM were chosen to be compared with fifty normal term newborns and preterm newborns respectively. The data were analyzed with Minitab 12.0 software.

RESULTOf the 3320 newborns, 711 (21.4%) were complicated with PROM. The morbidity of PROM was 21.4% (711/3320), among whom 9.69% (196/2022) were term newborns, 39.68% (515/1298) were preterm newborns, the differences between the term and the preterm newborns were statistically significant (P<0.001). Preterm newborns with PROM accounted for 72.43% of all PROM newborns (515/711). However, preterm infants only accounted for 30.01% of the newborns without PROM. Sixty-nine newborns with PROM had neonatal respiratory distress syndrome (RDS), incidence of which was 9.7% (69/711): 10 (5.1%) term newborns and 59 (11.5%) preterm newborns, of whom 3 developed broncho-pulmonary dysplasia Among all patients with PROM, 25% (178/711) newborns had different infectious diseases: 92 (12.9%) had pneumonia and 63 (8.9%) had septicemia, which totally accounted for 87.1% of the patients with infectious diseases, 23 (3.2%) newborns had other infectious diseases including peritonitis, purulent meningitis, urinary system infection, skin infection, perianal infection and conjunctivitis, which accounted for 12.9% of the patients with infectious diseases. Blood culture was performed for 163 newborns with PROM, the positive rate of the culture was 38.7% (63/163). The main pathogenic bacteria detected in blood culture were Gram-positive cocci (45.9%) and Gram-negative rods (54.1%). Gram-positive cocci mainly included Staphylococcus haemolyticus and Staphylococcus epidermidis (16/63). Gram-negative rods included K. pneumoniae (19/63) and Escherichia coli (9/63). Fungi were detected in two preterm infants (3.2%). There was no significant difference in the level of total serum bilirubin between term newborns and preterm newborns with PROM (P>0.05). Total serum bilirubin level of 37.1% of total preterm newborns with PROM exceeded 220 micromol/L, while it was 29.1% in term newborns with PROM (P<0.05). There was a significant decrease of blood platelet count (P<0.01) between the PROM group and the normal group. The myocardial enzymes including lactate dehydrogenases, aspartate aminotransferase, creatine kinase, MB isoenzyme of creatine kinase of PROM group were significantly higher than those of the normal group (P<0.05). Compared with the normal group, the average hospital stay of term newborns with PROM and preterm newborns with PROM were prolonged by 20.0% and 25.1% respectively, the average cost of hospitalization of them were increased 30.5% and 60.0% respectively.

CONCLUSIONPROM is harmful to newborns health in many ways. Studies on PROM should be enhanced.

Bacterial Infections ; epidemiology ; Case-Control Studies ; Female ; Fetal Membranes, Premature Rupture ; Humans ; Infant, Newborn ; Male ; Pneumonia, Bacterial ; epidemiology ; Pregnancy ; Respiratory Distress Syndrome, Newborn ; epidemiology ; Retrospective Studies

OBJECTIVETo explore the high-risk factors and analyze the clinical characteristics of massive pulmonary hemorrhage (MPH) in infants with extremely low birth weight (ELBW).

METHODSTwo hundred and eleven ELBW infants were included in this study. Thirty-five ELBW infants who were diagnosed with MPH were labelled as the MPH group, and 176 ELBW infants without pulmonary hemorrhage were labelled as the control group. The differences in clinical characteristics, mortality rate, and incidence of complications between the two groups were analysed. The high-risk factors for MPH were identified by multiple logistic regression analysis.

RESULTSThe MPH group had significantly lower gestational age, birth weight, and 5-minute Apgar score than the control group (P<0.05). The MPH group had significantly higher rates of neonatal respiratory distress syndrome, patent ductus arteriosus (PDA), early-onset sepsis (EOS), intracranial hemorrhage, pulmonary surfactant utilization, and death compared with the control group (P<0.01). The multiple logistic regression analysis showed that 5-minute Apgar score was a protective factor for MPH (OR=0.666, P<0.05), and that PDA and EOS were risk factors for MPH (OR=3.717, 3.276 respectively; P<0.01). In the infants who were discharged normally, the MPH group had a longer duration of auxiliary ventilation and a higher incidence rate of ventilator-associated pneumonia (VAP) compared with the control group (P<0.05).

CONCLUSIONSA higher 5-minute Apgar score is associated a decreased risk for MPH, and the prensence of PDA or EOS is associated an increased risk for MPH in ELBW infants. ELBW infants with MPH have a prolonged mechanical ventilation, a higher mortality, and higher incidence rates of VAP and intracranial hemorrhage compared with those without pulmonary hemorrhage.

Female ; Hemorrhage ; etiology ; Humans ; Infant, Extremely Low Birth Weight ; Infant, Newborn ; Logistic Models ; Lung Diseases ; etiology ; Male ; Pneumonia, Ventilator-Associated ; epidemiology ; Respiratory Distress Syndrome, Newborn ; epidemiology ; Risk Factors

OBJECTIVETo study the effect of pregnancy-induced hypertension syndrome (PIH) on complications in very low birth weight (VLBW) preterm infants.

METHODSThe VLBW preterm infants were enrolled as research subjects, and according to the presence or absence of PIH in their mothers, they were divided into PIH group and non- PIH group. The incidence of major complications and length of hospital stay were compared between the two groups.

RESULTSThere were no significant differences between the two groups in gestational age, birth weight, sex, incidence rate of maternal diabetes, and use of antepartum hormone. The PIH group had a significantly higher rate of birth of small-for-gestational-age infants than the non-PIH group. The PIH group had a significantly lower incidence rate of bronchopulmonary dysplasia (BPD) than the non-PIH group, while there were no significant differences between the two groups in the incidence rates of apnea of prematurity, necrotizing enterocolitis, retinopathy of prematurity, and intraventricular hemorrhage-periventricular leukomalacia, and the length of hospital stay. There was no significant difference in the incidence rate of neonatal respiratory distress syndrome between the two groups, but the PIH group had a significantly lower proportion of infants who used pulmonary surfactant than the non-PIH group.

CONCLUSIONSPIH can alleviate respiratory complications and reduce the use of pulmonary surfactant and the incidence rate of BPD in preterm infants.

Bronchopulmonary Dysplasia ; epidemiology ; etiology ; Female ; Humans ; Hypertension, Pregnancy-Induced ; Incidence ; Infant, Premature ; Infant, Very Low Birth Weight ; Pregnancy ; Pulmonary Surfactants ; therapeutic use ; Respiratory Distress Syndrome, Newborn ; epidemiology

OBJECTIVETo investigate the short-term clinical outcomes of neonates of secundiparous mothers, and to provide a reference for the clinical practice after the change in birth policy.

METHODSA cohort study was performed for the parturients and their neonates born in Yongkang Maternal and Child Health Care Hospital in Zhejiang, China between June 2015 and April 2016. According to the parity of the mother, the neonates were divided into primiparous group and secundiparous group. The short-term clinical outcomes of neonates were compared between the two groups.

RESULTSA total of 4 091 neonates who met the inclusion criteria were enrolled, and there were 2 023 neonates in the primiparous group and 2 068 in the secundiparous group. In the secundiparous group, most mothers (57.16%) were aged 26-34 years, and 16.49% were aged above 35 years. Compared with the primiparous group, the secundiparous group had a significantly higher rate of births by cesarean section (42.55% vs 25.06%; P<0.05). The percentages of neonatal respiratory distress syndrome (NRDS; 8.6% vs 3.4%) and transient tachypnea of the newborn (TTN; 7.2% vs 2.6%; P<0.05) in hospitalized neonates from the secundiparous group were significantly higher than in those from the primiparous group.

CONCLUSIONSElderly parturient women are not the major population of secundiparous parturients. The neonates of secundiparous mothers have a higher rate of births by cesarean section, which might be associated with increased percentages of NRDS and TTN in hospitalized neonates from the secundiparous mothers.

Adult ; Cesarean Section ; statistics & numerical data ; Cohort Studies ; Female ; Humans ; Infant, Newborn ; Parity ; Pregnancy ; Respiratory Distress Syndrome, Newborn ; epidemiology ; Tachypnea ; epidemiology